Homebirth midwives: bringing third world causes of childbirth death to the first world

Asia, old woman with grandchildren

You really have to hand it to homebirth midwives. Who else could resurrect third world causes of childbirth death in the first world?

Like their ideological soulmates, the vaccine rejectionists, they imagine re-enacting the “olden days.” And just like the vaccine rejectionists, who are single handedly bringing back, measles, whooping cough, and other vaccine preventable diseases that routinely killed children in the “olden days,” homebirth midwives are bringing back intrapartum stillbirth.

Intrapartum stillbirth is the death of a baby during labor. It is extraordinarily rare in the US today. A woman who shows up at a hospital in labor with a live term baby is almost certain to give birth to a live baby. Not so in the third world. Asphyxia (lack of oxygen) during labor is a leading cause of death in countries where women lack access to hospitals and obstetricians. Why? Because birth attendants in the third world have no way to tell if a baby is not receiving enough oxygen in labor and no way to fix it by C-section or forceps even if they could tell.

Similarly, homebirth midwives also can’t seem to tell if a baby is not receiving enough oxygen in labor, and when and if they do figure it out, they lack access to the obstetricians, anesthesiologists and operating rooms that could easily save the baby’s life.

Consider these two cases of homebirth death recently in the news:

1. ‘Perfectly healthy’ baby boy suffocated in womb:

The baby’s parents, Sarah Williams and Emmet Heneghan, had given evidence the previous day. Mr Heneghan described the scenes from that night in their home in Louisburgh, Co Mayo, in May 2011 as “farcical” as the baby’s heartbeat began to fade.

He had suggested that they go to the hospital, but the midwife’s car would not start so they had to travel in his.

Ms Williams also gave evidence that a doctor had told her that if they had left for the hospital earlier, her son would be alive.

Self-employed midwife Christina Engel, of Ballinrobe, Co Mayo, said she called the hospital to declare an emergency transfer as soon as she noticed the foetal heartbeat decelerating.

2. South Carolina has suspended the license of a free standing birth center and two of its midwives because of an intrapartum stillbirth.

The woman, who arrived about 9:43 p.m. Aug. 29, was 8 centimeters dilated by the next morning, according to a 7:15 a.m. exam, the documents said.

Then between 6:05 and 6:53 p.m. Aug. 30 [11 HOURS later!], the baby’s heart rate dropped from the 130s to the 110s while in utero. Just before 7 p.m., the documents note that “oxygen was applied at 10 liters per minute via a face mask.” But no physician was consulted, the documents said.

Around 7:30 p.m., the midwives took the woman to the hospital in her own vehicle, without consulting a physician or calling for an ambulance, documents said.

The midwives contacted Piedmont Medical Center and told them they were “en route with a mother that has fetal intolerance to pushing, meet us downstairs,” documents said.

When they arrived, a cesarean section was performed, and the baby was born without a heartbeat. Hospital personnel tried to revive the baby but were unsuccessful, state documents said.

Another third world cause of death is lack of access to someone with knowledge and equipment for advanced resuscitation:

3. The story of a blogger who is “pursuing healthy living.”

Finally, after 1 ½ – 2 hours of pushing, her head was coming out. I wasn’t sure she was really coming until they told me to reach down and grab her. She was still pink at this point. I reached down and grabbed her (under her arms I think) and started to help pull her out. They told me later that the moment that I grabbed her was when her coloring and muscle tone suddenly changed. They had never seen a baby’s color change so quickly before. She went from pink to white/blue, and she fell limp. I remember her head falling to her shoulder as I was grabbing her. From the sudden change in color and muscle tone, Sara knew something was wrong. As I pulled out most of her body, Sara took her from me and immediately started trying to get her to breathe.

What is it with these homebirth midwives and their refusal to call an ambulance?

During the pregnancy, Sara had explained that in case of transfer, she just drives to the hospital and calls ahead so they know she is coming and what is going on. If she called an ambulance instead, we’d have to wait for them to get to us, THEN drive to the hospital, so just driving herself gets the emergency to the hospital faster. (Not to mention that ambulances cost $$$$$.) It was also night time and we only live a mile from the hospital in a small town, so there should be virtually no traffic and she could drive quickly.

And, as usual, the mother refuses to take responsibility for her choices. In this case, apparently, its God’s fault:

It is hard to describe, but I genuinely felt peace at that point, that it didn’t really matter whether my baby lived or died or had complications, because I knew that whatever the outcome was, would be the way God wanted it to be. He wouldn’t make or allow this situation to happen if it weren’t for a reason. If God wanted her well, He would provide the miracles for her to live. If she died, then that was what was intended for her. God wouldn’t let something happen that was not the plan. Things were happening the way they were for a purpose. So I didn’t need to worry.

And once again, the drive to the hospital, in the midwife’s car turns into a farce:

On their way to the hospital, they hit a dip in the road too fast, which triggered some sensor in the car, shutting off all the electronics, and thus shutting down the car. Somehow, the BlueTooth was still working though, and they called 911. Sara had my baby in the towel and they started running (without shoes on, I might add) to the hospital. The 911 dispatcher had tried telling her to wait in the car, but she told them the policemen could catch up with her, as she was NOT waiting… After running maybe 1/3 of a block, a policeman picked them up and drove them the last 3 blocks to the hospital…

The end result:

When my baby arrived at the hospital, the doctors and nurses administered CPR and tried 3 times to intubate her. They gave her 3 doses of adrenaline/epinephrine, but couldn’t get a good heartbeat. At one point, they could get a heart rate of 60 (and it fleetingly even went up to 80), but it wasn’t a full open-close valve action…It was really just a flutter, forcing the heart to move without really beating. The heartbeat that they did get was short-lived and she never took a breath…

Dr. Pedi then tried breaking the news to DH that there wasn’t anything else they could do and that she was gone…

These are anecdotes to illustrate the point, but hard data shows the extraordinary epidemic of third world deaths at first world homebirth.

In March of this year, Judith Rooks, CNM released the most comprehensive homebirth statistics ever collected in the US.

The overall all rate of perinatal death at planned homebirth with a LICENSED midwife was 800% higher than comparable risk hospital deaths. While the rate of intrapartum death of term babies in hospitals is so small that it is effectively zero, in just one year alone three (out of 1235) babies dropped into a homebirth midwife’s hands unexpectedly dead … just as often happens in the third world.

Homebirth increases the risk of neonatal death because homebirth has resurrected third world causes of death in the first world.

Way to go, homebirth midwives!

  • Jenna MIles

    I encourage everyone to watch this documentary, it presents arguments from both sides.
    https://www.youtube.com/watch?v=KvljyvU_ZGE

  • Jenna MIles

    Studies show that home birth does not increase the risk of maternal or neonatal death. In fact, the Netherlands, with a 30% homebirth rate, has a lower infant mortality rate. The United States has one of the worst in the developed world. Developed countries where midwives attend normal births instead of doctors, show that it is better for mother and baby. Birth is a natural process, our bodies were made to birth babies. Most of the time, things go fine. Many complications that arise are in fact due to earlier interventions. An epidural leaves a woman unable to get up and move around, which can help labour progress. When a fetal heartbeat dips, sometimes a change in position is sufficient, something harder with an epidural. An epidural means a c section or forceps are more likely, as the mother sometimes has a harder time pushing. People who have epidurals often must give birth flat on their backs, which means gravity is working against them. I am not anti epidural, I believe in choices in childbirth. Their pregnancy, their baby, their birth, their choice. Provided they know what the risks are in all their options. Hospitals often give women a certain amount of time they can be in labour, even if mother and baby are doing fine. So Pitocin and other drugs and interventions are used to speed things up. But Pitocin causes stronger and more painful contractions, which sometimes can be hard on the baby, as the contractions are more intense, so c sections, forceps, or vacuum assisted deliveries are more likely. Of course, sometimes induction or speeding along labour is necessary for mother or baby. But many times, labour can just be slow, and the baby will come out sooner or later. Doctors nowadays are too quick to just give a woman a c section, when a vaginal birth in fact is possible. Mostly this is done to avoid being sued. C section rates are climbing, and people seem to view them as a simple operation, like getting your tonsils out. While they are routine surgeries, they are major abdominal surgery. A vaginal birth where possible is usually better. And the idea of just getting a c section because one does not want to go through labour or to plan the baby’s birth date is on the rise, known as ‘too posh to push’. This idea is preposterous. The baby will come when they are good and ready, and taking them early from the womb, except when medically necessary, is not a good idea. I want to be clear I am not anti hospital birth, not anti c section, I am very thankful we can have all these interventions to save mothers and babies, what I am against is treating birth like it is an emergency all the time. Intervening when things are going great will only necessitate more interventions. When an animal is in labour, the first thing you always do is nothing. Let them do their thing , but keep an eye on them in case things go wrong, and then intervene. Of course, humans, being bipedal, having bigger fetal heads and narrower pelvises, are in a different situation, but the same principle applies. Nature knows best, and if we intervene when nothing is going wrong, we will only create problems.
    Back to the issue of home birth, it is a woman’s choice how and where she wants to give birth. A low risk woman is perfectly capable of delivering at home safely as long as they have a qualified midwife, emergency equipment, and ability to transfer quickly to the hospital. Mothers and babies are less likely to pick up infections in their own home, the mother often has a lower stress level, and she can receive one on one care not possible in a hospital setting.
    That being said, there are times when a home birth is not advisable. Such as if a mother lives too far from the hospital to transfer quickly, or if for any reason her pregnancy is high risk.
    Doctors are trained to take care of problems, abnormalities, so they often see them where they don’t exist. Midwives see birth as normal until proven otherwise. We need to have a system where midwives take care of low risk births, and doctors handle the high risk and the emergencies. This is the recipe to lower infant and maternal mortality.
    People often see midwives as these old grannies from hundreds of years ago, women who often didn’t even wash their hands, and just gave the woman a spoon to bite on. Maybe hundreds of years ago they were, but today they are trained medical professionals.
    If a woman prefers to have a doctor, that is fine, as long as she is educated on the subject. If she wants a homebirth and she is low risk, that is her call. If she wants a midwife attended birth in a hospital setting, her choice. It should also be said that midwives are well trained to pick up fetal distress, and are capable of monitoring heart rates with hand held dopplers. Electronic fetal monitors limit the movement of the mother, and this can slow labour down.
    I should also say I am not a doctor or a midwife, I have simply researched the subject of childbirth. I admit I am not a medical professional, this is y opinion based on my knowledge, and I encourage mothers-to-be to explore all their birth options and find the one they are comfortable with.

  • Lucy

    Ok, question for the MDs and CNMs here. I’ve never had EFM with my hospital births, except during pushing. I have very fast (less than 2 hour labors) and have arrived at the hospital at 8 and 7 centimeters with my first two births. I’m pretty sure I was on the monitor for a little bit and then allowed to move around before I started pushing. I remember a the nurses listening with a Doppler during ctx. Is the CFM something I should insist on next time? They do use it during pushing

    • alanagh

      Continuous monitoring only for phase 2 i believe unless there is risk identified. if no risk then intermittent monitoring (eg: 15min-20min every hour or two) is okay. but guidelines may have changed – anyone?

  • Carolina

    In the past 6 weeks, I’ve had three friends lose late-term babies: 35-weeks with a cord injury; 36-weeks with a placental aburption; 40-weeks, cause unknown (autopsy is today). The mothers all did everything right, and it wasn’t enough. I just don’t undertand how anyone could be so casual with the life of their precious babies.
    And I think I’m going to demand a c-section at the earliest possible date if I manage to conceive again.

    • moto_librarian

      Oh Carolina! I can’t even fathom how awful those losses must be.

    • Jenna MIles

      C sections in my opinion should not be done when there is no problem with mother or baby. It is major abdominal surgery, and a vaginal birth is much safer when mother and baby are doing fine. It is terrible when a mother loses her baby, and often it is nobody’s fault. Sometimes it just happens. Especially with cord injuries or placental abruption. People who practice homebirth are doing what they believe is better for them and their babies. They aren’t being casual in the least.

      • Daleth

        I chose a c-section because each way of giving birth has its own risks and benefits, and I really did not want to expose my babies or myself to any of the risks of vaginal birth (such as, for the babies, brain damage or death caused by cord compression or placental abruption, or for me, severe perineal tearing that in addition to being horrifically painful and requiring a long time to recover from, could cause fecal incontinence).

        I’m so glad I had that choice. Why would you want to take that choice away from me?

      • Medwife

        Sometimes they are done because there is an unacceptable (to the mother and care provider) risk of a problem developing. Your opinion on the justifiability of another woman’s decision on c/s vs vaginal birth is, frankly, worthless.

  • Bombshellrisa

    http://www.washingtonmidwives.org/documents/MAWS-News1112.pdf
    “Now in WA state, Licensed Midwives (LMs) have the ability to direct Registered Nurses. The success of this bill effectively broke down a significant barrier to LMs working in federally qualified health centers and obtaining hospital privileges. LMs can now also hire RNs as birth assistants and work with CNM students without concern…..the passage of this bill allows Licensed Midwives to directly approach hospitals and seek privileges. You will no longer need an OB to countersign any orders. This means that, operating under the scope of our licenses, we can admit clients, deliver their babies and act as the baby’s care provider.” This terrifies me, but I can’t imagine a hospital (especially one with practicing CNMs) wanting to give privileges to a CPM.

    • Allie P

      Are CPMs the same thing as LMs? They allow high school graduates with some correspondence courses give directions to highly trained college grad RNs? The RNs I know boss around wet behind the ear resident doctors. I can see these folks getting RAVAGED

      • Bombshellrisa

        From what I understand, LM is licensed midwife. So an LM can be a CPM but CPMs aren’t always LMs.
        I have yet to hear of any of the local CPMs getting hospital privileges, but it alarms me that they will be working with CNM students. Those are RNs already, what could they possibly be learning from birth junkies? And what is a CPM going to be doing at a hospital? They can’t do anything. They shun things like pitocin, epidurals and fetal monitoring. They claim it’s the hospital that creates fear and makes women lay on their backs to labor and deliver. Why would they want to work in one?

        • amazonmom

          Like hell I would take orders from anyone but a CNM or MD. Would the provider be required to follow hospital policy? I doubt the LM would want to do that. I admit I’ve only ever seen CPM midwives personally in WA.

          • Bombshellrisa

            Well, it’s WA that this law was passed in. I don’t understand the motivation at all, if you want the privilege then you have to be a real healthcare provider. A degree in Asian studies or even graduating pre-med and then being a doula for years doesn’t make you qualified to have hospital privileges. It would make them accountable for hospital transfers in a way that is only optional now, I doubt they have thought about that. They probably see it as a way to cover any lapses in care up to the point of transfer, while still being able to bill for their entire fee, plus the one where they charge to go to the hospital with you.

          • amazonmom

            I’m glad I’m not working L&D:)

          • Squillo

            This is just a guess, but I suspect the law is partly geared to ensuring that LMs can hire and direct RNs in homebirth and birth center practices, and to alleviate any concern among RNs that their licenses would be in jeopardy in the event of a bad outcome. “The state-sanctioned midwife, my boss, made me do it.”

            They must know that they aren’t going to be given privileges in any hospital, but it looks good to the consumer to say they could, if only those mean doctors weren’t so afraid of them.

        • Squillo

          Also remember that the license is issued by the state, while the CPM is the credential issued by MANA.

      • ecemie

        An LM is just a CPM/DEM/lay midwife who has been licensed (and poorly regulated) in the state in which s/he practices.

    • Squillo

      I can’t see any hospital risk manager advising that a CPM get privileges. I can’t imagine any hospital staff committee–populated largely with MDs–agreeing to it.

      Plus, hospitals also require clinicians to carry med-mal, so unless CPMs are going to start ponying up for it, this bill will mean nothing on a practical level. It’s a political move, designed so CPMs can say,”See? We could practice in hospitals if we wanted to.”

      • Bombshellrisa

        True. It’s just another ploy.

      • bliss

        Washington State LM’s do carry malpractice insurance

        • Squillo

          They may, but the law doesn’t require it, so I’d be interested to learn what percentage actually do.

          WA LMs are given the opportunity to purchase malpractice insurance. The statute requires the state to assist midwives in attaining med-mal (in response, I believe, to the fact that none of the commercial carriers would carry them) by setting up joint underwriting association in which all state med-mal carriers must participate.

  • Lifetip

    God, what a chilling image. A barefoot woman holding a dead baby, running desperately toward the hospital because she know that the expertise and technology there provide the only glimmer of hope for the baby she already killed.

    Knowing the mother could have given birth in that hospital, and none of that would have happened.

  • Bambi Chapman

    On an article about the birth center, a mother shared that she lost her baby there just a few months ago. So, there are two deaths so far.

    • Jenny

      Yep and pretty much everyone ignored it in order to keep fapping about how they loved giving birth at the center. How awful.

      • Bambi Chapman

        I’m in contact with her

  • mindiloohoo

    I have never been more grateful for my (medicated!) hospital VBAC. It wasn’t planned. I had a c-section scheduled, but went into labor a few days early, and it was progressing quickly and normally, so I went with it.

    Had I been at home, this could have been my son. When my water broke, it was full of meconium. Twice, his heartrate dove into the 80s. Thanks to CONSTANT monitoring, we were able to catch it immediately, and while they prepped the OR, find a position he could tolerate. Both times, my doctor and I had the “c-section or continue” talk. Both times, kiddo bounced back, but doc and I decided that the third time would mean another OR trip, one I would have gladly taken. And guess what? Even with the evil interventions, monitoring, alarms, and OB, kiddo still came out the traditional hatch. Had we been at home, we might not have known what was going on, and I wouldn’t be holding a happy, healthy, 1-week old.

    • The Computer Ate My Nym

      Congratulations on the new baby!

      It’s interesting to note that the evil monitors allowed you to find a position that the then-fetus could tolerate so actually are part of what gave you the chance to have a healthy VBAC. Not what the NCBM would have you believe.

      • mindiloohoo

        Exactly!

    • Jenna MIles

      I don’t consider these interventions to be evil, the opposite in fact. It is wonderful everything turned out great in your case. My only objection is over intervention in a natural process. If nothing is going wrong, don’t intervene. If there are concerns, by all means do so. If a woman feels better giving birth in hospital, fine. If she prefers to be at home and she has had a normal pregnancy, she can do so.

  • Very impressive article. I have read each and every point and found it very interesting

  • Antigonos CNM

    WHAT is “fetal intolerance to pushing”? [!!!]

    • Squillo

      Homebirth midwife for: “I had no idea the baby was in trouble until it came out blue.”

    • Dr Kitty

      What the rest of us call foetal distress.

      • Antigonos CNM

        That’s what I’d call it, too. I was being sarcastic, and thinking of my granddaughter, in the throes of the Terrible Twos. I envisage a fetus pummeling the uterus with its little fists and shouting “No! Don’t wanna out!”

    • Anj Fabian

      I’d guess FHR decels with slow/no recovery during pushing.

  • SK

    “The Birth Story Part 11: The First Days After
    After a while of holding her, I could tell she was losing more body heat and it started to be awkward holding a baby that was getting colder and colder.”

    My middle school students use “awkward” in a completely different context. Her writing makes her sound cold to my ear.

    • SK

      And I feel guilty for judging, but still!

    • Bryant

      A woman loses a baby and decides to blog about her traumatic experience, and your first thought is that she sounds like a cold middle schooler? And you think it’s important enough to tell other people so?

      The irony.

  • Captain Obvious

    It was just a “a birth with a bad outcome.” ??? They were obligated to contact a pkysician for meconium, for prolonged labor, for category II or III FHR tracing. But they want to appeal the suspension because the law hasn’t enforced the mandatory contacting of physicians in the past, so why should they have to be subjecting to the law if other midwives got away with it in the past. Maybe because to many babie are dying. They don’t need a new law, just enforce the one they already have.

    • Jenny

      What I don’t get about everyone saying, “Why did they shut down the whole center! I go there and now I need to find a new care provider!” is…. good god, wouldn’t you want to know your caregivers are competent? If there is a question about whether or not the whole premise of safety for the birth center (adequate consultation with physicians) is intact, wouldn’t you want someone to investigate that? I know I would. I go to a hospital cnm practice and I am counting on the fact that they ALL consult with the OBs when there is a question, and would be investigated if they were not. Accountability is the only way we can have trust.

      • Captain Obvious

        In the hospital, you have many different doctors and midwives practicing under what they feel are their own practice types. Some doctors jump at the chance to augment with pitocin, others will wait on pitocin after several hours. There are some protocols, but variations exist. That is totally different than a midwife group practicing in their own birth center. It is fit to expect this midwife group that is working together to practice under the same practice guidelines. If these two numbnuts don’t call their backup physician for meconium, a protracted labor, or a change in the fetal HR, than I too would assume that that is generally accepted by their partners and may be how this small group practices at that birth center. I may be over generalizing some, because a doctor’s bad outcome who practices in a group of five probably wouldn’t have the whole practice shut down. But at least in the hospital, the oversight committee would have a root cause analysis for this sentinel event, and the remaining doctors would have to answer for that too. Who is reviewing the birth center’s sentinel event? No one. So the birth center got shut down until facts can be sorted out.

        • Young CC Prof

          That’s a good point. When a hospital screws up royally, a bad outcome that absolutely should never have happened, the authorities expect that the hospital’s own channels will investigate the mishap. So, unless there’s evidence of genuine criminal activity, like someone stealing drugs or deliberately murdering patients, the authorities won’t step in unless the hospital does absolutely nothing, or there is a pattern of major screwups with no action.

          Here, the practice doesn’t have such channels, so it was shut down.

          • Captain Obvious

            Have you ever heard of a birth center having a risk management department? Hospitals do.

          • Sue

            Birth Center risk mgt department = oxymoron

        • Bombshellrisa

          First they would have to understand the definition of “sentinel event”.

      • Bombshellrisa

        If you are in the hospital and you feel like you aren’t getting answers you want or you think that an OB has to be consulted, you CAN request they consult their backup OB. Even during your pregnancy you can do this, and they have to make sure that you get to consult about care.

        • Jenny

          That is good to know and I will keep that in mind over the next few months. I got a lot of peace of mind during my last pregnancy when I learned that they did consult with the OB over anything that was out of the ordinary – stuff I wouldn’t even have thought to ask, “Hey did you talk to the OB about this?”

          That’s why I think it’s so important for caregivers to have accountability. As a patient, I try to be educated but I’m not a health professional. I’m not in the best position to know what my caregiver’s limits are. I feel much safer within a regulated hospital system for all the reasons that Captain Obvious describes.

  • Bambi Chapman

    One thing I noticed was the fact that the midwife told her things that went on, like “I took heart tones and all was well”. Having the midwife tell her things from HER perspective and telling her how things were just seems to me like she is planting stuff in moms head so that mom doesn’t question. Mom seems to know how things went rather coherantly, but the midwife is saying “I did this, don’t you remember?”. Yeah, something smells funky there.

    • Squillo

      If she took heart tones, it should be in the chart. Of course, a strip would be evidence, but EFM is a tool of Satan.

      • Bombshellrisa

        Chart!!!! Hahahaha that is funny, homebirth midwives have other ways of knowing, charting is a tool of the patriarchy to oppress homebirth midwives

        • Squillo

          Right. There’s a reason failure to chart properly is considered reason for action against a physician’s license, and a reason hospitals get all over their docs who don’t do it. If it isn’t in the chart, it didn’t happen. It’s part of professionalism and accountability, both of which seem to be anathema to this segment of homebirth midwifery.

          • Bombshellrisa

            And some of the stupid things that get charted about by homebirth midwives mean nothing in the grand scheme of things. You can write how many times that counterpressure was applied, if the patient was sitting in the tub for 30 minutes or that lavender essential oil diffused was “helpful” to calm the patient, but if the chart doesn’t document vitals or fetal heart tones, or major things like meconium staining or cervical dilation, it’s just a bunch of useless paper.

          • Elaine

            We interviewed home birth midwives (CPMs) but decided against using them for various reasons, which I don’t regret. One thing that put me off was their insistence that they are not medical professionals. It basically read to me as “we are making excuses for not taking responsibility for the outcome of your birth”. I’m a medical provider and I take responsibility for what I do, so I would expect no less from someone who is attending the birth of my child. Jeez.

    • Antigonos CNM

      [1] In the majority of cases, trying to get an FHR during a contraction is difficult if not impossible, especially if using inadequate equipment. [2] What matters even more is whether the fetal bradycardia persists [and how long it persists] after the end of the contraction.

      So, if the midwife gets a nice FHR in between contractions, she still doesn’t have a clue whether signs of fetal distress are present — until the distress is so bad that the baby is almost fetally compromised.

      There’s a reason that EFM isn’t done for only 30 seconds at a time.

  • Zornorph

    Yea, God, I read more of this crazy story and it’s just horrible. The midwife puts her on a ‘crazy’ diet (her words, not mine) and says: “The *only* women’s births for which
    she ever needed to do a hospital transfer in her 18 years of delivering
    babies (at a rate of about 1/week) were for women that did not follow
    her diet as they were supposed to. ALL of her women that followed diet
    have had a birth (first pain to baby in their arms) of 4 hours or less.
    (She says it’s the flour that extends labor.) And *none* of her girls
    in the last 10 years have even torn!! (nor gotten episiotomies for that
    matter.) She doesn’t even do sutures – she never needs that skill
    anyway. Her girls stop bleeding anywhere from 2 days to two weeks after
    birth (not the typical 6 weeks doctors tell you) and regain energy so
    much more quickly. And she had never lost a mother or baby in birth.
    (Sorry, I just ruined that 18-year streak.)”

    I wonder if there were other women with bad outcomes where ‘Sara’ just said they must have cheated on their diet. I’d be willing to bet outside of this woman’s hearing, she’ll still claim to have a perfect score and will simply put this loss down to the woman sneaking some white bread or something.

    Seriously – flour extends labor? I’d like to hit Sara over the head with a 100lb sack of white flour.

    • Jenny

      I didn’t read that part. I’d help you lift that sack of flour. That’s disgusting.

    • Squillo

      A midwife who’s only dealt with one serious emergency over eighteen years isn’t one I’d be hiring for my homebirth. It’s like choosing a doc who’s never done even minor surgery as the guy to take with you for a year in Antartica.

      It’s clear Sara didn’t even have the most basic clue about resuscitation: baby was given CPR on the bed.

      • Zornorph

        She didn’t need those skills because thanks to her natural medicine, nothing would ever go wrong!

    • Anj Fabian
      • Jenny

        I went and read more of the story. Some of the stuff the midwife was saying and recommending is nuts.

        “She said she didn’t want me going into real labor already tired out from continual contractions that weren’t going anywhere. So she had me take 2x my calcium supplement (a particular kind that she finds gives unique results) and to go take my daily ginger bath now. This particular supplement tends to dull real labor pain or help the pains of non-real labor go away……She told me to take more of the calcium supplement every 15 minutes for an hour so we could nip this in the bud and get it to stop… She called back after the first 2 times of taking it, and I was still having contractions, now at 9 minutes apart. She was surprised they weren’t going away and she felt that with taking that much of this particular supplement, if the contractions were still there, it was probably in fact real labor. (I stopped taking the supplement at that point.)”

        http://pursuinghealthyliving.blogspot.com/2013/06/the-birth-story-part-2-labor-begins.html

        • Zornorph

          I’d say she sounds like a witch doctor, but that would be an insult to witch doctors. What I did note is that none of her ‘natural’ medicine seemed to work the way it was supposed to but the woman STILL doesn’t see how she was led up the garden path. And even after her baby was dead, what she most wanted was to have ‘Sara’ with her – not her husband, mind you, not her children, but this charlatan who was responsible for the death of her baby.

      • Fred

        That midwife has manipulated this woman’s recollections greatly. It is sickening.

        “I did not recall this *at all* (probably because I was squeezing my eyes closed through most of the pushing phase and I didn’t really realize what she was doing), but Sara told me later that through the pushing phase, she had checked the baby’s heartbeat many times with the doppler. Apparently, I would tell her “okay, I’m done now – you can stop that now – get that off!” when she had the doppler on… I guess it was pretty uncomfortable having that on during contractions… She’d just say, “sorry, I need to do this…”

        The baby’s heartbeat was great every time.”

        The quote used by Dr Amy above: “They told me later that the moment that I grabbed her was when her coloring and muscle tone suddenly changed.” [So the mother never saw the baby with good colour?? It disappeared the moment she grabbed the baby?? ]

        And later:
        “Something she told me was that not only was my baby’s color great while she started coming out, but she also had some muscle tone. She said that the moment I took her was when she lost muscle tone (fell limp) and her color instantly drained. ”

        “I initially wrote this post with my understanding from Sara’s and DH’s explanations of what had happened. After reading and re-reading it many times, I felt uneasy about posting it and sent a draft to Sara to see what she thought. I’m glad I did, because I apparently had the details wrong.”

        • Jenny

          To me, this was one of the grossest part of the whole story – the midwife’s fairly blatant manipulation to cover up her own responsibility.

          • Squillo

            Reminds me of the way the man who molested my childhood friend for years tried to convince her that she was misremembering after she finally reported him.

          • Jenny

            Abusers tend to have the same MO no matter what kind of crimes they are doing. 🙁 I’m sorry about what happened to your friend.

        • Lisa Cybergirl

          It sounds almost like gaslighting. I wish I hadn’t gone to read it at the blog.

    • LibrarianSarah

      This woman is a pox on the name Sarah. It’s a good thing that she spells it differently. She still has to change it though. She has a choice of Jenny, Abby, Liz, Talyor, and Jessica. These were the names of girls who were mean to me in middle school and are thus beyond redemption. She has 72 hours to change it.

      • I don’t have a creative name

        LOL

      • Bombshellrisa

        Actually, she changed her midwife’s name to protect her privacy-so it’s not really Sara (thank goodness, since I have cousins and friends named Sarah that I adore)

        • LibrarianSarah

          Well then, the author has 24 hours to change the pseudonym to one of the names above or I’ll call my lolyer.

      • kumquatwriter

        Provided she omits the bitch-mitigating e… (says Abbey)

    • Tired Momma

      Of course all if that wonderful information came from the MW and couldn’t be verified. MWs and Used Car salemans have the same level of honesty.

      • MichelleJo

        That’s an insult to used cars salesmen.

    • Antigonos CNM

      I’d prefer organic, stone-ground, whole wheat, myself.

    • ol

      If a woman keeps the prescribed by the MW diet it is a good sign for MW: it is very likely that this woman will conform to all other MW’s words and actions, she already trust her MW. She won’t contradict to the MW, it is easier in all aspects to work with the person in such agreeable mood. (Sorry for my English, it is very difficult to me to express such things)

  • I don’t have a creative name

    If you take that woman’s reasoning to its logical end, all murders are okay on some cosmic level, because that’s when God wanted the victim to die. Sick.

    No, lady, God allowed that baby to die because He does not micromanage human affairs. We are not robots. Love cannot exist without freedom. We make our choices, and we either reap the rewards or suffer the consequences thereof. You chose to give birth to that baby with an attendant who lacked medical knowledge, in an environment with no hope of rescue in the event of a catastrophic emergency – and then you had just such an emergency. THAT is why your baby died.. not God.

    What happened to you was tragic, and I know you never intended it to be this way. In time, when the shock has worn off a little, I hope you are able to see this situation for what it is, and thus warn other women so they don’t end up in your same terrible situation. Despite my extreme disagreement for how you portrayed God’s role in this, I am truly sorry for your loss. I cannot even imagine such pain.

  • I feel ill reading this.

    • I don’t have a creative name

      Same.

  • Zornorph

    I think the freakiest part of the last story is the ‘Hooray! I got to smell the birthy smells’ part. That just seems sick to me.

    • Jenny

      Grief makes people think funny things. When my daughter was dying, I was happy that I got to hold her without the tubes because when she had the tubes in, I was constantly worried about kinking one and killing her by accident. This doesn’t mean I didn’t want her treated. It just means that when we got to the end and I knew she was dying, I was happy for any little scrap of anything. So I can’t judge “I got to smell the birthy smells.” When your kid dies, you are not rational about it, and you think all sorts of weird things.

      The rest of it is just heartbreaking.

      • thanks for sharing something so personal. It is a good reminder that judging the way women deal with their babies passing away has vast repercussions- the woman in the story is not the only one affected by the comments. It could be kicking someone when they are down.

        • Jenny

          Yeah, I’ll say all day long that I believe hospital birth is safer, and the homebirth midwife who attended this woman’s birth sounds like a complete whackaloon…. the whole thing is a tragedy that might have been prevented or mitigated with the right personnel and equipment. But I can’t judge the mom’s reactions. Even the part about “what’s the point of the bandaid” and “but I didn’t want footprints on neon pink paper.” Yeah, it’s weird. But… you get weird. You fixate on stupid little details that you actually have control over instead of the fact that the thing you thought could never happen to your family just did.

      • wookie130

        I am so sorry for your loss. I completely get what you’re saying here.

    • Burgundy

      What’s the big deal of the “birthy smells” anyway? I had my 2nd daughter in a baby friendly hospital. I hold her for 2 seconds after the birth then asked the nurse to clean her up. I did not like the smells nor the white gooey stuff on her. (I had my first one in a different hospital and the nurse gave me the baby after the team cleaned her up a bit, which I greatly appreciated).

      • Zornorph

        It seems if the mother doesn’t smell the birthy smells then she won’t feel bonded to the baby and won’t love it. Seriously, that’s the claim.

        • LibrarianSarah

          What are we, ducks?

          • Ainsley Nicholson

            According the quacks, we are.

      • amazonmom

        I work at a Baby Friendly hospital and was offered the chance to hold my baby skin to skin before her bath. I told the nurse NO its ok, let hubby help you bathe her first. I can’t stand the “birthy smells”.

      • Mishimoo

        Mine all came out pretty clean, but I don’t like the smell of amniotic fluid which is apparently weird. *shrugs*
        I was in a Baby Friendly hospital too and with the last one I was offered various bathing options once I was in the ward. I was tired, so tried to take the nurse up on her ‘offer’ to bathe the baby for me. Her response: “Oh, I think it’s so special for the mum to give the first bath, you don’t want to miss out on such a special occasion.”
        I took a deep breath and changed the subject before blurting out “Well, what was the point of asking then?”

      • me

        I delivered my last child in a hospital that is in the process of becoming “friendly” (funny, they seemed friendly enough to me) and I was able to hold her skin to skin for about an hour uninterrupted after delivery. I didn’t notice a smell at all. It was wonderful to be able to hold her for so long and nurse her before they took her to do all that jazz. But “smells” had nothing to do with it. She was alive and healthy and so was I.

  • bodnoirbabe

    That woman’s use of the “It’s Gods will” bullshit reminds me of that modern joke/parable about the man in a flood. For those not familiar, a man is in his house when it starts to rain heavily. A police man comes by and tells him they are evacuating the area as they suspect a large flood. The man waves the policeman off and tells him “God will save me.” A few hours later, the water is flooding into his home. A neighbor comes by in a boat and tells him to get in. The man waves him away and states “God will save me.” A couple more hours and the man is on the roof of his house, as the flood waters have risen. A helicopter comes by and throws him a rope, urging him to get in. The man refuses the help and waves the helicopter away saying “God will save me.” A few hours later and the man is rushed away in flood waters and dies. When he gets to Heaven and meets God he says “God, I had such strong faith that you would save me and yet I died. Why did you forsake me?” God looks at him for the idiot he is and says “Son, I sent you a policeman, a boat, and a helicopter.”

    That woman has refused the miracle of science, things that could save her baby created by the amazing intellect and ingenuity that “God” has given to man. She has pushed away all of Gods help and yet still says it is Gods will that that baby die.

    In short – fuck her.

    • The Bofa on the Sofa

      The woman’s use of “God’s will” reminds ME of the movie MASH, and Duke’s assessment of Frank Burns:

      Dammit, Henry, Frank Burns is a menace! Every time a patient croaks on him he says it’s “God’s will” or somebody else’s fault.

    • Jocelyn

      You know, that’s exactly the story I thought of too.

  • Ra

    I am a Christian. Being a Christian is a large part of my identity–it is part of my job, my church, my family life, my personal choices, my community, my financial state, my living arrangments, and pretty much everything else that affects my life.
    I absolutely believe that there is a God and that He has a plan for each and every life. That said–I firmly believe that God gave us brains for a reason beyond just facilitating physiological processes.
    You can’t knowingly jump off a 100 ft cliff without safety equipment and then say it was God’s plan for you to be paralyzed from the neck down. Stupidity has consequences. Things like physicis, gravity, biochemistry, etc. have natural laws that come into play regardless of what you believe. Yes, God probably knows what was going to happen as a result of your own use of your own brain and your own body; but, that doesn’t mean he “willed” it to happen. You make the decisions, and you experience consequences.

    • Lisa Cybergirl

      Thanks for posting this. It’s wonderful to hear from an intelligent, sensible, realistic Christian – so often we only hear from the crazies (they’re louder).

    • Happy Sheep

      I was raised a Catholic and the phrases my priest and the community said often, with scriptures to support was “God helps those who help themselves” and “God meets you halfway”. I don’t really identify with the church any longer, but I don’t know how any self proclaimed christian can declare that they can just passively expect their God to save them from their own arrogance and stupidity.

  • Captain Obvious

    Does that book, From Calling to Courtroom, have any advice to midwives why they don’t call an ambulance? Because, you know, a dead baby costs less than a living handicapped baby. Sorry, that does sound grim.

    • Young CC Prof

      Believe it or not, that’s why some SUVs have lower liability insurance rates than it seems like they should: Because in the event of a serious crash, the folks in the other vehicle are more likely to be dead and less likely to be dreadfully and expensively injured. (SUV passengers are about equally safe.)

    • Being married to a PI lawyer, it’s sad but might be true…dead babies are incredibly cheap and that really does make for a rather awful incentive.

    • Are you nuts

      Except that lay midwives are not financially on the hook for botched deliveries because they don’t carry malpractice insurance. Sure you could sue them personally but unless they are very wealthy, you won’t get very far.

      • Squillo

        Right, but in the case of Lisa Barrett and Gloria Lemay, the ultimate lack of legal consequences was based on a baby that was not born alive. A stillborn baby isn’t granted “personhood” and cannot have been the victim of murder or negligent homicide. So yes, a baby born dead could look better to a midwife–especially an “independent” midwife–than one born alive who is at high risk of dying later.

        • When do we start valuing women’s trauma as a result of a birth gone wrong? Pregnancy and childbirth are not easy – to undergo them and then have the purpose for doing so negligently with held seems cruel. Surely, we need to recognize the physical toll and psychological toll – and should be awarding damages accordingly.

          • Squillo

            In the U.S., we’ve assigned responsibility to the tort system to do that. To the extent that it works–and there are lots of problems, obviously–it depends on the clinician having med-mal.

        • Fred

          And the Coroner has no jurisdiction over a stillbirth,

    • Squillo

      I don’t know, but I’m sure the notion of having a somewhat informed and objective witness (EMT) at the scene isn’t exactly reassuring. Wasn’t it the EMTs who found the pulse in one of Lisa Barrett’s dead-baby disasters, leading to a spot of legal trouble for her?

    • Bombshellrisa

      “To the family who transports to the hospital in labor: Keep your mouth shut about the homebirth.

      If the family feels intimidated by questions at the hospital: Keep your mouth shut. Pretend that you don’t understand. Play dumb. It’s not against the law to be dumb.

      To the family involved in a third stage or neonatal hospital transport: Only report that the mother was in labor and all of a sudden the baby just came out! A spontaneous labor will not be investigated.”
      This is advice from a homebirth midwife featured in “From Calling to Courtroom”.

      • The Bofa on the Sofa

        This REALLY needs to be part of informed consent. Did you know that your midwife is being advised to do this? You really think they care about your baby?

        • Bombshellrisa

          They complain that all OBs do is worry about “covering their butts”. So why the need to write an ebook about how to do the same for themselves? Notice some of the advice here: get a good lawyer, ask the families you care for to give money towards your defense, keep yourself “full of love”. Here is the whole quote:

          “Go for the best lawyer. Ask him to make an exception for the amount that he will charge you. Do not settle for the lawyer who tells you that you cannot win. You can get a lawyer who has worked for the “other side” — the best out there. Tell him/he r who you are, what you need, and show them who we are. Even though they may have not danced in our world does not mean that they will not help us. Make them see how we work for so little money. The commitment from the families…ask the families to al l give a 100 dollars to your case. When you work with your lawyer, write the facts down on paper. Keep it simple. Show the lawyer that you can and will help with the legal work as there is a lot to do as long as you do not get in his way. Trust in the lawyer who you get, and if it is not the right one then get another. Listen to your intuition always.Keep the faith up. Use the experience as a time for self growth. Keep your heart open, keep your mind open, and keep yourself full of love. Do not hate those that are doing this to you. Pray and learn to love them. This is the most important or you will not attract the right one to help you. Look at the “enemy” as small children who have been abused”

          She doesn’t care about the families and she doesn’t care about the babies. The person quoted is Brenda Scarpino.

          • Bambi Chapman

            Speak of the devil

          • Bombshellrisa

            I hope that didn’t hurt you that I quoted her from that disgusting book. Sickening to hear how she is so willing to throw everyone else under the bus to save her own skin.

      • Bambi Chapman

        My midwife is featured on that site/book. It’s chilling.

  • EllenD

    So much angers me about the “healthy living” blog. The hospital tries to get foot and hand prints for her as a momento and she complains that they don’t use the right shade of pink and that it’s not acid free paper. She complains that they gave her support group information, She complains that they put a bandaid on the baby they were actively, desperately trying to resuscitate.

    And of course the midwife is without blame. As is she. In fact, it’s all God’s plan, as evidenced by this gem, “I think that even if she had made it to the hospital faster (or if she had been born in the hospital to start with), God would have interfered in some different way, as necessary, to ensure that His ultimate plan for her had been intact.”

    God would have made sure that her baby died anyway. Right. Because that is what God does.

    • The Bofa on the Sofa

      I think she needs to find a nicer god.

    • Young CC Prof

      I have some measure of sympathy for her. If she accepts that the hospital almost certainly could have delivered her a perfectly healthy child, then she accepts that she killed her own baby. It takes a very great soul indeed to accept something like that and go on living.

      • Then your purpose becomes sparing other woman from the same pain and better understanding how you came to the decision in the first place.

        • Young CC Prof

          And there are some parents who have made that journey, and I applaud them for it as I grieve with them.

      • Clarissa Darling

        She does not accept responsibility at all, she hides behind “God’s Plan”. Everything that she did or didn’t do she attributes to God guiding her so that his ultimate plan of the baby’s death could be fulfilled. If a murder confesses to killing someone and says ” yeah I pulled the trigger but only because it was God’s plan” would that constitute them taking responsibility or having remorse? I think not.

        • Young CC Prof

          No, she isn’t taking responsibility, I agree. My point is that I can kind of understand why she isn’t capable of it, not right now, anyway.

          • Clarissa Darling

            I am of 2 minds about this. On the one hand I understand how she could be in denial because facing the death of your child must be beyond horrible, on the other hand there are people who truly believe that all decisions and circumstances in their life are attributable to a higher power and therefore they take responsibility for nothing. Case in point -the midwives who repeatedly say “it’s not my fault some babies just die” and continue to practice. If this woman is in the second category I have a hard time understanding her.

      • Are you nuts

        Either God killed her baby, or she did… and the latter is too terrible for her to contemplate. It feels a lot better to think this is part of a grand plan and this baby was destined to die in the birth canal.

      • Bryant

        Nobody can be sure that she would have had a successful birth in the hospital, except possibly the people who were there. Which we weren’t. We can only make guesses.

        • Amy Tuteur, MD

          But we can say a couple of things for sure:

          1. The baby would have had a better chance of surviving.

          2. You are just trying to make excuses for hideous care.

          • Bryant

            1. Probably. But we don’t know that for sure for this specific case, because we don’t know why the baby died. So many people here seem to be overly certain of things after reading a few blog posts from a still-grieving mother untrained in medicine.
            2. What excuse did I give?

          • jenny

            Just because there is no guarantee the baby would have survived in the hospital (and I agree with you, there’s not really any way to know for certain) doesn’t mean that the midwife provided adequate care, or that the baby wouldn’t have had better odds with a better care provider, in a setting more amenable to monitoring and emergencies.

          • Bryant

            I’m not trying to suggest that this midwife in this situation provided, or midwives in general provide, adequate care. What I’m objecting to are the proclamations, made in certainty, that “she killed her baby”. 1. We don’t and can’t know that. 2. It’s probably not the right time to pile more emotional trauma on them.

          • jenny

            Absolutely. I lost a baby to a birth accident, and in my opinion, the only thing that separates those of us who have, from those of us who haven’t, is luck. In my case, I had the bad luck to have an unpredictable complication and a precipitous birth in the same labor, so I was away from anyone who could really help in a way that could have significantly changed the outcome. In her case, she had the bad luck to have a complication (no way to know if it was predictable or not) and a what sounds like a horrible midwife, and so she was away from a place where she could have gotten better help, too. Lots of people make the “right” choices and lose their babies despite that, and plenty of people make the “wrong” choices and nothing bad happens. She got very, very unlucky, and she and her baby deserved far better than they got.

    • HolyWowBatman

      Some people have a stunning ability and depth to avoid personal responsibility.

      • The Bofa on the Sofa

        I think Young CC Prof’s comment below hints at it, it’s not really about avoiding personal responsibility, it’s basically still just denial. As mentioned, she knows that if she admits that the baby could have been ok in the hospital, it would show it to be her fault, so she denies it.

        It’s not really ability and depth, it’s actually a very simple and shallow way to avoid responsibility. Just deny it.

  • Jessica

    When Rooks released her data my jaw dropped. Over 40,000 planned hospital births in Oregon in 2012, and not one intrapartum death. That is just amazing to me.

    I didn’t like my L&D nurse. She annoyed the crap out of me. But to this day I still appreciate that she was watching out for my baby. She didn’t like his heart rate during the second stage and wanted me on oxygen. I don’t know what the issue was – she was having a hard time keeping the monitor on my belly – but the fact that she was paying attention to him at that point meant the world to me, and I’m thankful for that. He was born healthy and just fine after less than 50 minutes of pushing, but I’m guessing that was a sign he would not have tolerated hours and hours of pushing. But without monitoring how would anyone know that?

    • Anonymous

      This is a problem with the whole homebirth movement. Affable but completely incompetent women being friendly with the mother until there’s complications or they get paid. The mother gets someone that talks to them and gives them warm fuzzies, but doesn’t care about the actual child making it through. When my wife had ours with nuchal cord and our OB was unavailable, the OB that stepped in I knew to be a cocky @ss but he was fantastic and in his element. I’d seen him deliver kids before when I was in the maternity ward but I’d never seen him crack a sweat like he did with my wife. Thanks entirely to him our daughter is happy and healthy. We still send him flowers on her birthday. The problem is that the HB community seems ready and willing to trade the child’s life for the mother’s feelings.

      • Jocelyn

        “The problem is that the HB community seems ready and willing to trade the child’s life for the mother’s feelings.”

        As I get closer to my due date, this seems more and more bizarre and foreign to me. I couldn’t care less about what my labor and delivery are like – I don’t care if I have another episiotomy (I really didn’t like the recovery from my last one), I don’t care if I have a c-section, all I care about is that my daughter is born safely. That’s all I care about. I just want her to be healthy and safe. How could you put something else above that?

      • Jessica

        I had the best of both worlds with my OB – professional, highly trained, conscientious, but he was also warm, affable, and caring. Women are being tricked into believing that (a) it’s not possible for an OB to be warm and compassionate, and (b) that birth is not something that requires someone with actual medical training and the ability to deal with an emergency.

      • Squillo

        I think in some cases the affability is the crappy practitioner’s armor. Witness the once-popular Dr. Biter. People tend to judge clinicians by things like bedside manner rather than competence, which most of us aren’t really in a position to judge–at least, not until too late.

        • The Bofa on the Sofa

          Keep in mind, that is sort of self-selection. Crappy practitioners, pretty much by definition, have to be affable, or they won’t survive.

          • Squillo

            Exactly.

  • PrimaryCareDoc

    From the blog: “My baby was laying on a towel on my bed near my feet when Sara initiated CPR”

    Yet ANOTHER midwife doing CPR while the baby is on the soft bed. What is up with these people??

    • Captain Obvious

      They carry everything with them that can be found in a hospital. And they are all trained in neonatal resuscitation. :-/

    • Kalacirya

      I don’t know CPR, but I’m assuming doing it on a soft bed would just lead you to smushing whoever it was into the bed, instead of pumping at the heart?

  • Bombshellrisa

    The midwife wasn’t wearing shoes? Yet another reason to give birth in the hospital, nobody is making themselves comfy and taking their shoes off “holding the space”.
    When are women going to ask detailed questions about transfers? For all that they believe themselves so “educated”, do they really believe you just call the hospital and everyone drops what they are doing and has everything ready and waiting at the doors to the ER? Even if you are preregistered, there have to be assessments done before anyone knows what the plan of care is going to be. I get incredibly irritated with midwives who just say “we will just go to the ER” or say they just call the hospital in case of transfer. The worst transfer I ever saw involved a young woman attempting an HBAC. She was asystole for eight minutes before she arrived at the hospital. They were able to do a crash section, transfer the baby to a NICU and revive her, only to have both mom and baby die two days later in separate hospitals. That was heart wrenching. And very third world.

    • Karen in SC

      what a tragic waste of life! All in the name of “taking control” or “an idyllic birth experience.”

      • Bombshellrisa

        It was awful-I don’t think anyone who was there that night will ever forget what they saw. They worked so hard on the woman and the baby.

        • Dr Kitty

          So sad.
          There was a case here few years ago of a maternal brain hemorrhage where a peri mortem CS was done in the ER during CPR.
          Neither mother or baby survived and staff still talked about it as the worst day of their working lives months later (and this is a Belfast ER, where the some of the staff had dealt with bombings).

          THAT was a horrible act of chance…dying during HBAC…less so.

    • Amy M

      They really believe the “hospital is ONLY 10 minutes away.” And they don’t seem to realize that even if that were true, no one can hold her breath for 10 minutes. They also think that every emergency that could happen during a birth will come on slowly with warning signs…maybe a foghorn and lights? WHOOP WHOOP!!! WEEEOOO WEEOOO!! UTERINE RUPTURE APPROACHING AT 0200 HOURS. PREPARE FOR TRANSFER. WE REPEAT: UTERINE RUPTURE APPROACHING, PREPARE FOR TRANSFER, YOU HAVE 3 HOURS TO PREPARE. Oh! Hey! A uterine rupture! Lesseee…ok, call the hospital, pack a bag, whose car is in the best condition? Yours? Ok, let’s take yours…what else? A baby sitter for the other children…..

      • Squillo

        They also think that every emergency that could happen during a birth will come on slowly with warning signs…maybe a foghorn and lights?

        And even when it does, too many of them ignore them. Meconium? Not a problem. Stalled labor? Variation of normal. Late decels? Give ’em some blow-by. Those nasty OBs just want to cut you at every little sign something might be wrong.

        • Are you nuts

          Exactly!!! The woman in #2 had SEVEN HOURS between meconium stained waters and seeking medical help. And forty-five minutes between decelerated heartbeat and seeking medical help!! The baby certainly would be alive if they had gone to the hospital after seeing meconium, and probably would be if they had called an ambulance the second the heart rate started decelerating.

          • EmbraceYourInnerCrone

            Let see, I had meconium stained water when they ruptured my membranes, which they did because the OB did not like the looks of the External fetal monitor and wanted to start internal monitoring, ie put an electrode on my daughters scalp. This was fairly late in the delivery and when they saw the late decels and slow recovery, the OB decided to go for an episiotomy and use the vacuum to get her out faster. he also had the nurses page the NICU before he even started the episiotomy. They suctioned her out and kept an eye on her for the first day.

            Results: I have a college sophomore studying physics this fall. If I had not been where there was access to monitoring and medical professions who could do what was necessary to save her, she might have been one of those babies who “just wasn’t meant to live” I had a almost textbook easy pregnancy and delivery…right up until I didn’t.

            The other things that bug the hell out of me about the whole “we can just call an ambulance/go to the hospital” idea are : Most EMTs are not experts in neonatal resuscitation, if your baby is born blue and floppy they are probably going to bag, grab and run. I don’t think ambulances have the necessary equipment to resus a baby that small. Also does the closest hospital have an NICU? What if you need an ambulance (maternal hemorrhage/rupture) and they are all out? My friend works as an EMT a large city. On any given night they may have calls about heart attacks, strokes, gun shots wounds, overdoses or car accidents.

          • FormerPhysicist

            If you KNOW you are doing something rather dangerous, do it in the safest possible manner.

            Different example: The work that is being done now to acclimatize and desensitize allergic kids – is done in a hospital. They don’t say “This worked, go give your kid a pb&j out in the woods.”

          • The Bofa on the Sofa

            If you KNOW you are doing something rather dangerous, do it in the safest possible manner.

            But there’s the rub. If you DENY that what you are doing is dangerous, then you don’t have to be careful.

            Like the whole, “childbirth is inherently safe.”

        • Amy M

          Also, isn’t “emergency” by definition, something that moves very quickly? If you have plenty of time, it isn’t an emergency. So, those midwives, and by extension their clueless patients, believe there’s no such thing as an obstetric emergency, since there’s always enough time. Either that, or those emergencies always happen to other people..you know those other people who just happen to be in the hospital already where they could get an uneccesarian.

          • The Bofa on the Sofa

            They don’t understand that the goal of interventions is to prevent emergencies, not deal with them. If you have an emergency on your hands, you have acted too late.

        • stenvenywrites

          That — “the hospitals want to cut you at the first sign of trouble” — seems to be the argument, but my experience in 2 different hospitals was that in the major teaching hospital, the emergency equipment and staff were so much closer and readily available that we did NOT have to make the decision for c-section. If you have an OR and anesthesiologist just steps away, you can afford to wait until the very last moment to see if the potential danger resolves (as, thankfully, it did.) A shorter turnaround time allows for lengthier, more deliberate assessment. When you’re in some small regional community hospital, with equipment and surgeon thirty minutes away, however, you have to be more conservative and start prepping as soon as it looks like there MIGHT be a need for intervention headed toward you.

          • The Bofa on the Sofa

            Hey, hey, hey, hey….don’t be pulling your “making rational sense” crap around here.

      • Captain Obvious

        EFM does have alarms that go WHOOP. (Monty Python reference). And although EFM has not decreased the incidence of CP, it has decreased the intrapartum stillborn rate and neonatal seizure rate. I would hope Homebirth midwives would use EFM at home, but that would be so unnatural. As unnatural as a tub birth or rebozo. After watch my koi in my backyard pond, I have learned the male koi slam into the female koi’s belly when the eggs are ready to be laid. This helps expel the eggs from the female. I have lost a couple koi due to being egg bound (not being able to release the eggs). I even tried gently massaging and squeezing one in desperation of my favorite colored koi. Very natural behavoir to beat the female koi’s belly during egg entrapment. Hope the Homebirth midwives don’t try this.

    • The Bofa on the Sofa

      For all that they believe themselves so “educated”, do they really believe you just call the hospital and everyone drops what they are doing and has everything ready and waiting at the doors to the ER?

      Yes, and I can tell you way – because they are under the mistaken impression that midwives are some legitimate health providers.

      They are under the impression that a midwife can call the hospital just like paramedics and have the ED waiting for them, all prepared for transfer of care. As you note, and as Gene has affirmed, the ED gets a transfer like this, only in very select cases would they take the word of the MW. Most commonly, it is treated just like any patient who shows up on their own at the ED, which means first step is assessment and triage.

      These women get the idea that the hospital is going to just be waiting for them in the OR, ready to do an emergency c-section as they walk in the door. No, first step is, someone has to do an exam to determine what the problem is. They aren’t going to take the word of a midwife – ESPECIALLY when it is someone like a CPM, who is doing a homebirth particularly because they aren’t qualified to work in a hospital.

      • Bombshellrisa

        I forgot about that part-all those meaningless letters they add after their names DOES make an impression on some people.
        At the hospital where I work, we have had patients call ahead saying they “need the surgical room ready” for XYZ reason and yes, when they turn up in the ER they really do have a bone sticking out through their skin or really do end up needing surgery but there isn’t anyone that will just take a layperson’s order over the phone about a condition. And CPMs ARE laypeople.

        • EllenD

          Reminds me of the time my mother in law had a severe headache and consulted Dr. Google. She then told her husband she thought she had meningitis and went to bed. Her husband found her the next morning in a catatonic state. Upon arrival to the ER, he told the ER doc that she had meningitis. And it turned out she did. (She has made a full recovery, BTW)

          • anonymous

            How does that remind you of that? Google could just as easily have said she had some sort of brain parasite

          • Kerlyssa

            I got stuck on the ‘went to bed’ part. Who the hell goes to bed after learning they have meningitis? ‘I think I’m bleeding out, dear, I’m going to take a nap.’

          • The Bofa on the Sofa

            The other night, my wife was complaining about a muscle twitch in her arm. I looked it up on WebMD, and told her it might be Chagas disease. Has she been around any tropical insects lately?

          • Young CC Prof

            Hey, Dr. Google COMBINED WITH source selection, some common sense, context, and a basic layman’s knowledge of medicine can be useful. Just like any other reference.

          • Dr Kitty

            I had to explain to a young healthy man that he had globus hystericus, not epiglottitis.

            Dr Google does not have common sense.

          • Kerlyssa

            Google reacts to clickthroughs over time. It molds to your (online) personality. For example, it almost never shows ‘woo’ sites like Mercola to me unless I actually seek them out by typing in their site names. It’d be different for a fresh install of Google, or for someone with a different search history. Which is why it really is only as good as the person googling. A conspiracy theorist or a hypochondriac is going to get very different results for the same search terms.

    • Captain Obvious

      We have ambulances bringing women up to L&D vocalizing in pain ready to push the baby out on a regular basis. Once up in L&D, many of them are only 1-3 cm. if a midwife tells one she can just call the hospital and everyone will just drop everything and prepare the OR for a crash CS, you are mistaken.

  • The Bofa on the Sofa

    I am trying to comprehend the case where the midwife told the mom to reach down and pull out the baby herself.

    Is that something that is done?

    • Bombshellrisa

      Sometimes-Kourtney Kardashian did that, but she was in a hospital. I just think its sad that the midwives pinpointed that as “the moment” something went wrong with the baby. Couldn’t have possibly been their crappy non existent care.

      • Amy M

        It’s really hard to figure out what was going on in that story, though I suppose the midwives had no idea either.

        • Anj Fabian

          The birth story says that there was something unusual about the amniotic sac. It could have been that what they were thinking was the sac included a vasa previa.

          But that’s pure speculation. All we have to go on is the word of the mother and midwife, and women in labor aren’t reliable and as for midwives…I’d need a video recording or pathology report to corroborate anything a midwife says before I’d believe it.

          • Amy M

            Yeah…I was wondering if it was possible for a baby to be pink and alive and suddenly drop dead and go white and limp like that. Only thing I could think of was sudden significant blood loss, maybe snapped cord or placental abruption, but I don’t know squat about these things as I am not a medical professional in any capacity. Unless the midwife was lying and the baby was always limp and grey as soon as it emerged, suggesting oxygen deprivation for some time.

          • Bombshellrisa

            It seemed like a subtle way to get the mom to blame herself and not the midwives.

          • The Bofa on the Sofa

            To paraphrase Daniel Kafee

            And that’s why it had to be pink, right, Midwife? ‘Cause Lord knows, if you let a woman with a white and limp baby deliver herself without transferring her, and that baby died during delivery, you’d have a lot to answer for, wouldn’t you?

    • AmyP

      Yeah. I think I’ve seen this done several times in home waterbirthing scenes from the Business of Being Born–the mom just reaches down and pulls out the baby.

      • The Bofa on the Sofa

        So we have BOBB and Kourtney Kardashian as examples.

        Not inspiring me, I have to say.

    • Amy Tuteur, MD

      I offered it to all my patients and I did it myself with my own babies.

      • kerlyssa

        Part of me sees the appeal, and part of me wants to run away screaming. I imagine your line of work would have inured you to the ‘what if I drop them??’ fear, though. 😉

  • Squillo

    The birth center death details an attitude of “laissez-faire” that borders on the monstrous:

    *The mother was 8 cm. dilated at 7:30 a.m.
    * Four and a half hours later, no baby, and they notice meconium.

    * Six hours after that, the baby still isn’t born and… SURPRISE! The heartrate drops.

    *An hour and half passes before they decide to drive to the hospital, instructing the hospital staff to “meet us downstairs.” The baby is born via c-section, dead. Gee! Who coulda predicted that?

    The birth center released a statement saying the midwives “took appropriate emergency measures in transporting the laboring mother to the hospital.” Yeah. Too bad they ignored the law, good clinical sense, and any sense of morality for the seven-plus hours during which they sat around letting the baby die.

    • Young CC Prof

      What gets me is that the labor just went so long without progress. Twelve hours from transition to… oh, still no baby?

      Yes, some labors last a long time, but once you’re at 8 cm, things generally happen pretty fast. How exactly did they not recognize stalled labor?

      • The Bofa on the Sofa

        How exactly did they not recognize stalled labor?

        The same way that I failed to recognize the electrical problem that caused our furnace to short out: they are not qualified to do so, and lack the necessary knowledge. IOW, they are as incompetent at what they are doing as I am at HVAC. Then again, that’s why I call the furnace guy.

        • Young CC Prof

          Ah, but the difference is that you recognized that your furnace was malfunctioning.

          I don’t expect everyone on the planet to be able to diagnose a medical emergency, but I do expect competent adults to be able to recognize the obvious signs. An apprenticeship-trained midwife 300 years ago would have recognized the problems, though she wouldn’t have been able to do much about it, other than maybe get the forceps, if she had them and knew how.

      • Poogles

        “How exactly did they not recognize stalled labor?”

        Many of these NCBers do not recognize stalled labor or “failure to progress” as a real thing – they honestly believe it is something made up by OBs and hospitals in order to get women in and out of hospitals quickly so they can make more money. They frequently refer to it as “failure to wait” or “failure to be patient”, believing that the baby needs to be given the time to find it’s way out on it’s own and that speeding things up with pitocin is actually harmful because if the baby isn’t coming on it’s own, it obviously isnt’ “ready”.

        http://mamabirth.blogspot.com/2010/12/obstetric-lie-100-failure-to-progress.html (quotes – “An induced, undercooked baby may simply not want to come out yet. They can get
        it out. But not the way it normally comes. Let your labor start on its own, and then let it proceed on its own.” AND “If you learn nothing today, learn this: Nobody will know how you are
        progressing, if nobody puts their hands in your vagina. If you don’t want to be diagnosed as a failure, simply remove the test that does the diagnosing.”)

        http://www.nytimes.com/2012/05/27/magazine/ina-may-gaskin-and-the-battle-for-at-home-births.html?pagewanted=all&_r=0 (quote – “In Gaskin’s practice, the failure-to-progress diagnosis doesn’t exist. When we discussed my birth story, months later on the phone, she told me she thought a bath, a nap, a snack, some encouraging words — or just a chance to labor without the threat of various catastrophes hanging over my head — might have kick-started my labor.)

        • Amy M

          I read the comments–quite a few dissenters, considering the website, and they weren’t deleted. (the mamabirth one I am talking about) There were at least two calling BS on the “all women could give birth vaginally to live babies, given enough time” and “all OBs do Csections because they want to leave for dinner.”

        • thankfulmom

          I’m glad the nurse called someone to do a vaginal check on me…the house doc. discovered we had an emergency when she looped her finger around the prolapsed cord.

      • Squillo

        Probably they’d been lucky before. It seems that most babies can tolerate quite a bit, but some unlucky ones can’t. They’d gambled X number of times in the past and won. Why not this time? Too bad it was someone else’s life and baby they were gambling with. This is one time when the Gambler’s Fallacy might have been helpful.

  • Sarah, PharmD

    Yes, by all means, please blame GOD for your baby’s death, and not the incompetent “birth worker” you selected to care for you on the most dangerous day of you and your baby’s lives.

    • Amy M

      I read through the other posts relating to the story…she did mention the “what if the baby had been born in a hospital in the first place” but then decided god would have somehow killed the baby in the hospital because the baby was meant to die. I guess that is what helps her sleep at night. That was just a few weeks ago, I wonder if she will have more children and if so, will she head back to the hospital?

      • Amy H

        What she did is basically murder. God doesn’t typically prevent those.

        • auntbea

          Those people were meant to be murdered.

    • Karen in SC

      She must have missed the lesson on “free will” in her Bible classes.

      • AmyP

        Free will vs. predestination is an ongoing theological issue. There are real live Calvinists.

    • Are you nuts

      This makes me sick. God gave you a brain, a hospital full of doctors and a phone to dial 911. Your baby died in spite of God’s provision, not because of it.

  • The really disturbing thing is how many of those women were informed that the choice they were making included those risks? I stand behind a woman’s right to choose it (even though I can never imagine making the same choice myself) – but I absolutely believe that she must do so from a position of informed consent. Informed consent about the qualifications and scope of practice of her care providers, and informed consent about the real risks of birth relative to her other options. I applaud Dr. Amy for doing the work that homebirth midwives refuse to do – treating women with enough respect to tell them the truth.

    • Sarra

      I wish I could vote this up 1000 times.